gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2019-18-1-112-118gnck-1289Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEW«ХОЛОДНАЯ» ПЕТЛЕВАЯ ЭКСЦИЗИЯ ПЛОСКИХ ЭПИТЕЛИАЛЬНЫХ ОБРАЗОВАНИЙ ТОЛСТОЙ КИШКИCOLD SNARE POLYPECTOMY OF NON-PEDUNCULATED COLON POLYPSОзероваО. С.OzerovaO. S.noemail@neicon.ruВеселовВ. В.VeselovV. V.noemail@neicon.ruЧернышовС. В.ChernyshovS. V.noemail@neicon.ruФГБУ «ГНЦК им. А.Н. Рыжих» Минздрава РоссииРоссияState Scientific Centre of ColoproctologyRussian Federation201930032019181(67)112118Copyright © Озерова О.С., Веселов В.В., Чернышов С.В., 20192019Озерова О.С., Веселов В.В., Чернышов С.В.Ozerova O.S., Veselov V.V., Chernyshov S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1289

Как известно, петлевая электроэксцизия является стандартной методикой удаления полипов толстой кишки. Однако, при удалении даже небольших образований существует риск развития осложнений: кровотечение, перфорация стенки кишки, посткоагуляционный синдром. В связи с этим, небезынтересным представляется уделить внимание применению и распространению методики «холодной» полипэктомии, подразумевающей удаление образований толстой кишки без электровоздействия. Данная методика заслуживает большого внимания в силу своей простоты, а так же меньшего количества осложнений и хороших результатов радикальности удаления полипов менее 1,0 см в диаметре. Однако малоизученными остаются вопросы технического и методического усовершенствования, а именно определение оптимальной конструкции петли, необходимость предварительной подслизистой инъекции. Более того, не приводится отдаленных результатов лечения пациентов, не проводилось сравнительных рандомизированных исследований, основанных на удалении образований более 1,0 см в диаметре. Таким образом, существует ряд нерешенных актуальных вопросов, требующих необходимости проведения дальнейших исследований.

Hot polypectomy is a standard technique for removal of colon polyps. However, this technique is associated with a risk of complications: bleeding, perforation and postcoagulation syndrome. Therefore, it could be interesting to pay attention to using "cold" polypectomy for which means removal without electrothermal lesion. This technique deserves more attention due to simple use, less complications and good results for polyps <1 cm. There are some unclear issues, such as technical and methodological improvement of cold loop polypectomy, determination of the optimal construction of the snare and need for preliminary submucosal injection. No data on long-term results are obtained, because randomized studies are based on the removal of polyps >1 cm. Further studies are needed for evidence-based conclusions.

полипы толстой кишкиколоноскопияэлектроэксцизия полипа«холодная» полипэктомияclonic polypscolonoscopycold and hot snare polypectomyReferencesGupta N. Prevalence of advanced histological features in diminutive and small colon polyps. / N.Gupta, A.Bansal, D.Rao et al. // Gastrointest. Endosc. - 2012. -v. 75. - p. 1022-1030.Gupta N. Prevalence of advanced histological features in diminutive and small colon polyps. / N.Gupta, A.Bansal, D.Rao et al. // Gastrointest. Endosc. - 2012. -v. 75. - p. 1022-1030.Adler Douglas G. Колоноскопия: иллюстрированное руководство / под ред. Дугласа Г. Адлера; пер. с англ. И.С.Козловой; под ред. В.В.Веселова. -М.:ГЭОТАР-Медиа, 2016. - 224 с.Adler Douglas G. Колоноскопия: иллюстрированное руководство / под ред. Дугласа Г. Адлера; пер. с англ. И.С.Козловой; под ред. В.В.Веселова. -М.:ГЭОТАР-Медиа, 2016. - 224 с.Horiuchi A. Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy. / A.Horiuchi, Y.Nakayama, M.Kajiyama et al. // Gastrointest. Endosc. - 2014. - v. 79. -p. 417-423.Horiuchi A. Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy. / A.Horiuchi, Y.Nakayama, M.Kajiyama et al. // Gastrointest. Endosc. - 2014. - v. 79. -p. 417-423.Shinozaki S. What is the best therapeutic strategy for colonoscopy of colorectal neoplasia? Future perspectives from the East. / S.Shinozaki,Y.Hayashi, A.K.Lefor et al. // Dig. Endosc. - 2016. - v. 28. -p. 289-295.Shinozaki S. What is the best therapeutic strategy for colonoscopy of colorectal neoplasia? Future perspectives from the East. / S.Shinozaki,Y.Hayashi, A.K.Lefor et al. // Dig. Endosc. - 2016. - v. 28. -p. 289-295.Агапов М.Ю. Эффективность и безопасность «холодной» петлевой полипэктомии при полипах толстой кишки №8 мм. / М.Ю.Агапов, К.Д.Халин, А.С.Барсуков и соавт. // Экспериментальная и клиническая гастроэнтерология. - 2016. - №4 (128). -с. 56-60.Агапов М.Ю. Эффективность и безопасность «холодной» петлевой полипэктомии при полипах толстой кишки №8 мм. / М.Ю.Агапов, К.Д.Халин, А.С.Барсуков и соавт. // Экспериментальная и клиническая гастроэнтерология. - 2016. - №4 (128). -с. 56-60.Woods A. Eradication of diminutive polyps: a prospective evaluation of bipolar coagulation versus conventional biopsy removal. / A.Woods, R.A.Sanowski, D.D.Wadas et al. // Gastrointest. Endosc. - 1989. -v. 35. - p. 536-540.Woods A. Eradication of diminutive polyps: a prospective evaluation of bipolar coagulation versus conventional biopsy removal. / A.Woods, R.A.Sanowski, D.D.Wadas et al. // Gastrointest. Endosc. - 1989. -v. 35. - p. 536-540.Tappero G. Cold snare excision of small colorectal polyps. / G.Tappero, E.Gaia, P.DeGiuli et al. // Gastrointest. Endosc. - 1992. - v. 38 (3). - p. 310-313.Tappero G. Cold snare excision of small colorectal polyps. / G.Tappero, E.Gaia, P.DeGiuli et al. // Gastrointest. Endosc. - 1992. - v. 38 (3). - p. 310-313.Repici A. Cold polypectomy for subcentimetric polyps. / A.Repici, C.Hassan, E.Vitetta et al. // Endoscopy. - 2012. - v. 44. - p. 27-31.Repici A. Cold polypectomy for subcentimetric polyps. / A.Repici, C.Hassan, E.Vitetta et al. // Endoscopy. - 2012. - v. 44. - p. 27-31.Ichise A. Cold Polypectomy vs. Conventional Polypectomy. / A.Ichise, A.Horiuchi, Y.Nakayama et al. et al. // Digestion. - 2011. - v. 84. - p. 78-81.Ichise A. Cold Polypectomy vs. Conventional Polypectomy. / A.Ichise, A.Horiuchi, Y.Nakayama et al. et al. // Digestion. - 2011. - v. 84. - p. 78-81.Kim J.S. Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial. / J.S.Kim, B.I.Lee, H.Choi et al. // Gastroinest. Endoscopy. - 2015. - v. 81. -p. 741-747.Kim J.S. Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial. / J.S.Kim, B.I.Lee, H.Choi et al. // Gastroinest. Endoscopy. - 2015. - v. 81. -p. 741-747.Jung Y.S. Complete biopsy resection of diminutive polyps. / Y.S.Jung, J.H.Park, H.J.Kim et al. // Endoscopy. - 2013. - v. 45. - p. 1024-1029.Jung Y.S. Complete biopsy resection of diminutive polyps. / Y.S.Jung, J.H.Park, H.J.Kim et al. // Endoscopy. - 2013. - v. 45. - p. 1024-1029.Агейкина Н.В. Эффективность методов «холодного» удаления небольших (менее 10 мм) доброкачественных эпителиальных образований толстой кишки во время диагностической колоноскопи и в амбулаторных условиях. / Н.В.Агейкина, Е.Д.Фёдоров. // Эндоскопическая хирургия. - 2018. - №5. - с. 32-38.Агейкина Н.В. Эффективность методов «холодного» удаления небольших (менее 10 мм) доброкачественных эпителиальных образований толстой кишки во время диагностической колоноскопи и в амбулаторных условиях. / Н.В.Агейкина, Е.Д.Фёдоров. // Эндоскопическая хирургия. - 2018. - №5. - с. 32-38.Raad D. Role of the cold biopsy techniqyein diminutive and small colonic polyp removal: A systematic review and meta-analysis. / D.Raad, P.Tripathi, G.Cooper et al. // Gastrointestinal Endoscopy. - 2016. - v. 83. -p. 508-515.Raad D. Role of the cold biopsy techniqyein diminutive and small colonic polyp removal: A systematic review and meta-analysis. / D.Raad, P.Tripathi, G.Cooper et al. // Gastrointestinal Endoscopy. - 2016. - v. 83. -p. 508-515.Shinozaki S. Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: Systematic review and meta-analysis. / S.Shinozaki, Y.Kobayashi et al. // Digestive Endoscopy. - 2018. - doi: 10.1111/den.13173.Shinozaki S. Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: Systematic review and meta-analysis. / S.Shinozaki, Y.Kobayashi et al. // Digestive Endoscopy. - 2018. - doi: 10.1111/den.13173.Chey W.D. The channel occlusion technique: a novel method of retrieving polyps following snare resection. / W.D.Chey. //Am. J. Gastroenterol. - 2000. - v. 95. - p. 1608-1609.Chey W.D. The channel occlusion technique: a novel method of retrieving polyps following snare resection. / W.D.Chey. //Am. J. Gastroenterol. - 2000. - v. 95. - p. 1608-1609.Sano Y. A novel endoscopic device for retrieval of polyps resected from the colon and rectum. / Y.Sano, T.Kaihara, H.Ito et al. // Gastrointest Endosc. -2004. - v. 59. - p. 716-719.Sano Y. A novel endoscopic device for retrieval of polyps resected from the colon and rectum. / Y.Sano, T.Kaihara, H.Ito et al. // Gastrointest Endosc. -2004. - v. 59. - p. 716-719.Miller K. Polyp retrieval after colonoscopic polypectomy: use of the Roth Retrieval. / K.Miller, J.D.Waye. // Net. Gastrointest. Endosc. - 2001. -v. 54. - p. 505-517.Miller K. Polyp retrieval after colonoscopic polypectomy: use of the Roth Retrieval. / K.Miller, J.D.Waye. // Net. Gastrointest. Endosc. - 2001. -v. 54. - p. 505-517.Deenadayalu V.P. Colon polyp retrieval after cold snaring. / V.P.Deenadayalu, D.K.Rex // Gastrointest. Endoscopy. - 2005. - v. 62. - p. 253-256.Deenadayalu V.P. Colon polyp retrieval after cold snaring. / V.P.Deenadayalu, D.K.Rex // Gastrointest. Endoscopy. - 2005. - v. 62. - p. 253-256.Rex D.K. Quality in the Technical Performance of Colonoscopy and the Continuous Quality Improvement Process for Colonoscopy: Recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. / D.K.Rex, J.H.Bond, S.Winawer et al. // The American Journal of Gastroenterology. - 2002. - v. 97. - p. 1296-1308.Rex D.K. Quality in the Technical Performance of Colonoscopy and the Continuous Quality Improvement Process for Colonoscopy: Recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. / D.K.Rex, J.H.Bond, S.Winawer et al. // The American Journal of Gastroenterology. - 2002. - v. 97. - p. 1296-1308.Lee C.K. Cold snare polypectomy vs. Cold forceps polypectomy using double-biopsy technique for removal of diminutivecolorectal polyps: a prospective randomized study. / C.K.Lee, J.J.Shim, J.Y.Jang // Am. J. Gastroenterol. - 2013. - v. 108 (10). - p. 1593-600.Lee C.K. Cold snare polypectomy vs. Cold forceps polypectomy using double-biopsy technique for removal of diminutivecolorectal polyps: a prospective randomized study. / C.K.Lee, J.J.Shim, J.Y.Jang // Am. J. Gastroenterol. - 2013. - v. 108 (10). - p. 1593-600.Paspatis G.A. A prospective randomized comparison of cold vs hot snare polypectomy in the occurrence of postpolypectomy bleeding in small colonic polyps. / G.A.Paspatis, G.Tribonias, K.Konstantinidis et al. // Colorectal Dis. - 2011. - v. 13. - p. 345-348.Paspatis G.A. A prospective randomized comparison of cold vs hot snare polypectomy in the occurrence of postpolypectomy bleeding in small colonic polyps. / G.A.Paspatis, G.Tribonias, K.Konstantinidis et al. // Colorectal Dis. - 2011. - v. 13. - p. 345-348.Komeda Y. Factors associated with failed polyp retrieval at screening colonoscopy. / Y.Komeda, N.Suzuki, M.Sarah et al. // Gastrointest. Endosc. - 2013. - v. 77. - p. 95-400.Komeda Y. Factors associated with failed polyp retrieval at screening colonoscopy. / Y.Komeda, N.Suzuki, M.Sarah et al. // Gastrointest. Endosc. - 2013. - v. 77. - p. 95-400.Din S. Cold snare polypectomy: Does snare type influence outcomes? / S.Din, A.J.Ball, S.A.Riley. // Digestive Endoscopy. - 2015. - v. 27. - p. 603-608.Din S. Cold snare polypectomy: Does snare type influence outcomes? / S.Din, A.J.Ball, S.A.Riley. // Digestive Endoscopy. - 2015. - v. 27. - p. 603-608.Horiuchi A. Prospective, randomized comparison of 2 methods of cold snare polypectomy for small colorectal polyps. / A.Horiuchi, K.Hosoi, M.Kajiyama, N.Tanaka et al. // Gastrointest. Endosc. - 2015. - v. 82. - p. 686-692.Horiuchi A. Prospective, randomized comparison of 2 methods of cold snare polypectomy for small colorectal polyps. / A.Horiuchi, K.Hosoi, M.Kajiyama, N.Tanaka et al. // Gastrointest. Endosc. - 2015. - v. 82. - p. 686-692.Barros A.R. Safety and efficacy of cold snare resection of non-polypoid colorectal lesions (0-IIa and 0-IIb). / A.R.Barros, M.J.Monteverde, F.R.Barros et al. // Acta Gastroenterologica Latinoamericana. -2014. - v. 44. - p. 27-32.Barros A.R. Safety and efficacy of cold snare resection of non-polypoid colorectal lesions (0-IIa and 0-IIb). / A.R.Barros, M.J.Monteverde, F.R.Barros et al. // Acta Gastroenterologica Latinoamericana. -2014. - v. 44. - p. 27-32.Choksi N. Cold snare piecemeal resection of colonic and duodenal polyps >/=1 cm. / N.Choksi, B.J.Elmunzer, R.W.Stidham et al. // Endosc. Int. Open. - 2015. -v. 3. - p. 508-513.Choksi N. Cold snare piecemeal resection of colonic and duodenal polyps >/=1 cm. / N.Choksi, B.J.Elmunzer, R.W.Stidham et al. // Endosc. Int. Open. - 2015. -v. 3. - p. 508-513.Piraka C. Cold snare polypectomy for non-pedunculated colon polyps greater than 1 cm. / C.Piraka, A.Saeed, A.K.Waljee et al. // Endosc. Int. Open. - 2017. - v. 5. - p. 184-189.Piraka C. Cold snare polypectomy for non-pedunculated colon polyps greater than 1 cm. / C.Piraka, A.Saeed, A.K.Waljee et al. // Endosc. Int. Open. - 2017. - v. 5. - p. 184-189.Muniraj T. Cold Snare Polypectomy for Large Sessile Colonic Polyps: A Single-Center Experience. / T.Muniraj, T.A.Sahakian // Gastroenterology Research and Practice. - 2015. - doi: 10.1155/2015/175959Muniraj T. Cold Snare Polypectomy for Large Sessile Colonic Polyps: A Single-Center Experience. / T.Muniraj, T.A.Sahakian // Gastroenterology Research and Practice. - 2015. - doi: 10.1155/2015/175959Tutticci N.J. Cold endoscopic mucosal resection of large sessile serrated polyps at colonoscopy. / N.J.Tutticci, D.G.Hewett // Gastrointestinal Endoscopy. - 2018. - v. 87. - p. 837-842.Tutticci N.J. Cold endoscopic mucosal resection of large sessile serrated polyps at colonoscopy. / N.J.Tutticci, D.G.Hewett // Gastrointestinal Endoscopy. - 2018. - v. 87. - p. 837-842.Moss A.K. Standardisation of polypectomy technique. / A.Moss, K.Nalankilli // Best Practice & Research Clinical Gastroenterology. - 2017. - v. 31. -p. 447-453.Moss A.K. Standardisation of polypectomy technique. / A.Moss, K.Nalankilli // Best Practice & Research Clinical Gastroenterology. - 2017. - v. 31. -p. 447-453.Norton I.D. Efficacy of colonic submucosal saline solution injection for the reduction of iatrogenic thermal injury. / I.D.Norton, L.Wang, S.A.Levine et al. // Gastrointest. Endosc. - 2002. - v. 56. - p. 95-99.Norton I.D. Efficacy of colonic submucosal saline solution injection for the reduction of iatrogenic thermal injury. / I.D.Norton, L.Wang, S.A.Levine et al. // Gastrointest. Endosc. - 2002. - v. 56. - p. 95-99.Iishi H. Endoscopic resection of large sessile colorectal polyps using a submucosal saline injection technique. / H.Iishi, M.Tatsuta, S.Kitamura et al. // Hepatogastroenterology. - 1997. - v. 44. - p. 698-702.Iishi H. Endoscopic resection of large sessile colorectal polyps using a submucosal saline injection technique. / H.Iishi, M.Tatsuta, S.Kitamura et al. // Hepatogastroenterology. - 1997. - v. 44. - p. 698-702.Shirai M. Safer colonoscopic polypectomy withlocal submucosal injection of hypertonic saline-epinephrine solution. / M.Shirai, T.Nakamura, A.Matsuura et al. // Am J Gastroenterol. - 1994. - v. 89. - p. 334-338.Shirai M. Safer colonoscopic polypectomy withlocal submucosal injection of hypertonic saline-epinephrine solution. / M.Shirai, T.Nakamura, A.Matsuura et al. // Am J Gastroenterol. - 1994. - v. 89. - p. 334-338.Kim H.S. Hot snare polypectomy with or without saline solution/epinephrine lift for the complete resection of small colorectal polyps. / H.S.Kim, H.Y.Jung, H.J. Park et al. // Gastrointest. Endosc. - 2018. - v. 87 (6). - p. 1539-1547.Kim H.S. Hot snare polypectomy with or without saline solution/epinephrine lift for the complete resection of small colorectal polyps. / H.S.Kim, H.Y.Jung, H.J. Park et al. // Gastrointest. Endosc. - 2018. - v. 87 (6). - p. 1539-1547.

The authors declare that there are no conflicts of interest present.